Gender transition treatments for trans minors
Should Tennessee’s law restricting gender transition treatments for trans minors persist? Viewpoints from multiple sides.
Enjoying Framechange? Forward to a friend to help spread the word!
New to Framechange? Sign up for free to see multiple sides in your inbox.
Learn more about our mission to reduce polarization and how we represent different viewpoints here.
What’s happening
The Supreme Court heard oral arguments Wednesday in United States v. Skrmetti, a case centered around a Tennessee law restricting gender transition treatments for transgender minors. Observers have called it one of the most important transgender cases ever heard by the Court.
Tennessee passed the law in 2023 known as SB1, which prohibits the use of puberty blockers, hormone therapies, or surgeries for the purposes of “enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex.” The state permits similar treatments for minors in other circumstances (e.g., to delay early onset puberty or to reduce unwanted breast size) where gender identity is not a driver.
The plaintiffs in the case argue SB1 violates the Equal Protection Clause of the Constitution because it discriminates based on sex (e.g., an individual assigned male at birth is allowed to use testosterone therapy while an individual assigned female is not). Tennessee argues the law restricts certain medical treatments purely to protect the health of minors.
How we got here: The case reached the Supreme Court after the Biden administration appealed a federal appeals court ruling that favored Tennessee. That ruling reversed a lower court decision that had deemed the Tennessee law unconstitutional.
The plaintiffs, which include 3 transgender teens, their families, and a Tennessee doctor that provides gender transition treatments, are represented by US Solicitor General Elizabeth Prelogar and Chase Strangio, a lawyer for American Civil Liberties Union (ACLU) and the first openly trans lawyer to argue in the Supreme Court. Tennessee Solicitor General Matthew Rice and Tennessee Attorney General Jonathan Skrmetti represent the state.
Primary question: The plaintiffs are not asking the Court itself to strike down Tennessee’s law; rather, they are asking it to require the federal appeals court to conduct a stricter level of review known as “heightened scrutiny,” often applied in cases involving sex-based classifications. The federal appeals court initially applied a lower standard known as “rational basis review.”
During oral arguments, 5 of the 6 conservative justices expressed sympathy toward the state’s case while the 3 liberal justices seemed to side with the plaintiffs, suggesting a majority ruling in favor of the state is likely when it comes, expected by summer 2025.
Implications: Including Tennessee, 26 states have laws restricting gender transition treatments for minors in some capacity. Observers note the outcome of United States v. Skrmetti could have a significant impact on these laws and others relating to the transgender population.
This week, we bring you the viewpoints from multiple sides. Let us know what you think.
Notable viewpoints
More opposed to Tennessee’s ban on gender transition treatments for minors:
SB1 discriminates based on sex and should be subject to “heightened scrutiny.”
Supreme Court precedent from United States v. Virginia (1996) holds that “all” laws involving “gender-based classifications” are presumptively unconstitutional and subject to “heightened scrutiny.” Since SB1 restricts certain treatments based on the gender a minor was assigned at birth, it should qualify for “heightened scrutiny.”
Since SB1 only restricts access to certain drugs such as hormone therapies (e.g., estrogen or testosterone) when they are used in a way that is inconsistent with the sex a minor was assigned at birth, the law discriminates based on sex, violating the Equal Protection Clause of the Fourteenth Amendment. (Summarized from US Solicitor General Elizabeth Prelogar in oral arguments.)
“A cisgender boy who is a ‘late bloomer’ might receive testosterone so that he can undergo a typical male puberty alongside his peers. A transgender boy receives testosterone for the same reason. The difference between them is simply the sex they were assigned at birth and whether undergoing male puberty conforms to our expectations of what someone with that sex at birth should do.” (Chase Strangio, ACLU lawyer representing the plaintiffs, in The New York Times.)
Gender transition treatments are supported by leading medical associations and have been found to improve the wellbeing of trans minors.
Access to evidence-based gender transition treatments can save the lives of trans minors by reducing their risk of suicide. A 2020 study found that individuals who received puberty-delaying treatments had a lower risk of lifetime suicidal ideation than those who wanted the treatments but did not receive them. Approximately 9 in 10 individuals that wanted the treatments but did not receive them reported lifetime suicidal ideation.
Major US-based medical associations support protections for gender transition treatments for trans minors including the American Medical Association while 30+ medical associations worldwide support similar protections, a level of support that underscores the safety and importance of gender transition treatments.
“Medical transition as a minor saved my life. It built the firm foundation needed for treatments for depression and anxiety to begin to work. It was the missing puzzle piece in addressing my mental health conditions effectively. It was testosterone that allowed me to build the self-confidence I needed to see a future for myself and begin to have dreams and aspirations for my life.” (Henry Seaton, a trans man, in CNN.)
According to a systematic review published in 2021, less than 1% of trans people that undergo gender transition surgery regret the procedure, suggesting a majority of outcomes are positive.
A ruling in favor of Tennessee could infringe upon equal rights for trans people more broadly.
Trans people – accounting for an estimated 1.6M people in the US (<1%) – are one of the most vulnerable minorities in the country and deserve to be protected with equal rights like any other citizen. Laws banning access to gender transition treatments for trans youth threaten to violate their basic rights.
Upholding Tennessee’s ban could encourage conservative lawmakers to push for bans on similar treatments for adults, jeopardizing the general rights of trans people and their access to critical care more broadly.
Rather than an outright ban on gender transition treatments for minors, lawmakers should support tighter restrictions and more careful decision-making by minors and their parents around gender transition.
More supportive of Tennessee’s ban on gender transition treatments for minors:
SB1 specifically restricts certain medical treatments and does not discriminate based on sex.
SB1 does not discriminate based on sex; rather, it limits the use of puberty blockers and hormone therapies to specific medical purposes and applies these limits to either sex depending on an individual child’s circumstances. (Summarized from Tennessee Solicitor General Matthew Rice in oral arguments.)
Unlike previous cases requiring “heightened scrutiny," which involved “simple stereotyping” – such as whether men or women should have the same rights to purchase liquor – this case involves more complex medical questions and reviews of ongoing evidence that seem better left to state legislatures than the judicial system. (Summarized from Chief Justice John Roberts in oral arguments.)
There is insufficient evidence that gender transition treatments are safe for minors.
A landmark 2024 report commissioned by England’s National Health Service (NHS England) – the Cass Review – found that existing evidence on the impact of puberty blockers on gender dysphoria is weak and that the long-term health consequences are unknown. Several European countries – including England, Norway, Sweden, and Finland – have tightened rules on these treatments after being some of their earlier proponents globally.
Many minors experiencing gender dysphoria have been found anecdotally to be suffering from comorbidities such as depression and ADHD or were on the autism spectrum, suggesting there are underlying causes that should be looked at more discriminately before greenlighting transgender transition treatments that can permanently change the lives of minors.
The pediatric system in the US has been too quick to prescribe gender transition treatments without proper regard for the potential long-term effects – including loss of sexual function or sterility – on children. This eagerness is partially fueled by societal pressures to resist questioning the potential underlying causes of a child’s struggle with their gender identity and by how lucrative gender treatments can be for hospitals.
“I saw teenage girls, with no history of dysphoria, being approved [for gender transition treatments] after just one meeting with a therapist. My colleagues could see social contagion as a potential factor in other conditions like Tourette syndrome, tic disorders, and ‘multiple personalities.’ But with gender dysphoria, even suggesting there was a social aspect at work risked accusations of ‘transphobia.’” (Jamie Reed, former gender clinic case manager.)
While many proponents of gender transition treatments for minors cite a 2021 systematic review finding less than 1% of trans people that undergo a gender transition surgery later regret it, some of the methods used in the underlying studies are flawed due to “loss of follow-up bias.” By contrast, a 2021 study found that 87.8% of minors assigned male at birth among a sample that had been referred to clinics for gender dysphoria were classified as “desisters,” meaning they later identified as their original birth sex, suggesting a significant portion of patients would regret a potential gender transition treatment.
Restricting gender transition treatments for minors is within a state’s rights.
“Puberty blockers, hormone treatments and sex-reassignment surgeries are off-limits to kids in Tennessee. That’s the same common-sense approach we take with tattoos, alcohol and tobacco purchases, and other consequential decisions. Yet now, the federal government argues this age-conscious protection amounts to illegal discrimination.” (Tennessee Attorney General Jonathan Skrmetti in The Tennessean.)
States traditionally have a wide range of discretion to address and restrict areas of medical uncertainty, and denying Tennessee’s right to restrict gender transition treatments for minors would be a misunderstanding of the Constitution and states’ function as “laboratories of democracy.”
From the source
Read more from select primary sources:
Full text of SB1
Full text of the Fourteenth Amendment
Full transcript of oral arguments in United States v. Skrmetti
Archive of amicus briefs filed in United States v. Skrmetti
Full text of United States v. Virginia (1996)
Be heard
We want to hear from you! Comment below with your perspective on United States v. Skrmetti and we may feature it in our socials or future newsletters. Below are topic ideas to consider.
Do you support or oppose Tennessee’s SB1 law? Why or why not?
What are some arguments or supporting points you appreciate about a viewpoint you disagree with?
Snippets
A federal appeals court upheld a law passed by Congress earlier this year requiring TikTok to be sold to a buyer outside China or face a ban in the US. It determined Congress acted within its power to protect national security interests and that the ban was not unconstitutional. (See our previous coverage.)
The suspect in the murder of UnitedHealthcare CEO Brian Thompson in New York City remains at large. New York City police believe the suspect has left the city and have asked for the public’s help in locating him.
South Korean lawmakers filed a motion to impeach President Yoon Suk Yeol after he issued a surprise decree to impose martial law that was swiftly vetoed by parliament. The impeachment vote is set for Saturday.
President Joe Biden pardoned his son Hunter Biden for any offenses he may have committed between January 1, 2014 and December 1, 2024. The decision is a departure from the president’s previous claims that he would not use his executive authority to pardon his son.
Syrian rebels captured the strategic city of Hama – days after seizing Aleppo – and are advancing to Homs, Syria’s 3rd largest city. The sudden rebel advance has shifted the front lines in Syria’s 13-year-old civil war for the first time since 2020.
Give us your feedback! Please let us know how we can improve.
Music on the bottom
For all of our dance floor heroes, enjoy the epic build on this house track by Duke Dumont, “Love Song.”
Listen on Spotify, Apple Music, or Amazon Music.